Natalie Sartori, MEd, RHIA, CCS - Providence Hospitals 1

Transcription

1 FY 2009 DRG & ICD- 9-CM CHANGES Presented By: Natalie Sartori Coding Manager Providence Hospitals For FY 2009 CMS has added one new DRG for a total of 746 MS-DRGs. CMS has adjusted payment rates (- 0.9%) to account for documentation and coding practice changes that do nor reflect real changes in patient severity. In 2008 the rates were reduced (- 0.6%) culminating in a total reduction of (-1.5%) for Total Internal Biventricular Heart Replacement System - has been removed from MS-DRG 215 and assigned to DRG 001 Heart Transplant or Implant of Heart Assist System w MMC or DRG 002 Heart Transplant or Implant of Heart Assist System w/out MCC. MDC 001 CMS will evaluate DRGs 064, 065 & 066 for reassignment based on the new diagnosis code V45.88 S/P administration of tpa in a different facility within 24 hours prior to admission to current (receiving) facility. MDC AICD Lead & Generator Procedures MS-DRG 245 Title Revision AICD Generator Procedures includes procedure codes 37.96, & MS-DRG 265 New DRG AICD Lead Procedures includes procedure codes 37.95, & MDC 5 PTCA DRGs title revision for DRGs 250 & 251 removed the reference to AMI MS-DRG 250 Percutaneous Cardiovascular Procedure w/out Coronary Artery Stent w MCC MS-DRG 251 Percutaneous Cardiovascular Procedure w/out Coronary Artery Stent w/out MCC Providence Hospitals 1

2 MDC 18 CMS is revising the titles of MS DRGs 870, 871 & 872 to reflect severe sepsis: DRG 870 Septicemia or Severe Sepsis w/ Mechanical Ventilation 96+ hours DRG Septicemia or Severe Sepsis w/out Mechanical Ventilation 96+ hours w/ MCC DRG Septicemia or Severe Sepsis w/out Mechanical Ventilation 96+ hours w/out MCC MDC 21 Injuries, Poisoning & Toxic Effects of Drug CMS is adding Traumatic Compartment Syndrome ( ) to MS-DRGs 963 & 965 in MDC 24 Multiple Significant Trauma. FY 2009 applies the post-acute transfer policy to 273 MS-DRGs (37%) The time frame remains 3 days for HHS the proposal for seven days was not adopted. 331 New diagnosis codes 60 New Procedure Codes Staph Aureus Codes: Revised Code Methicillin Susceptible (sensitive) Staph Aureus septicemia i New Code Methicillin Resistant Staph Aureus septicemia Staph Aureus Codes: Revised Code Methicillin susceptible (sensitive) Staph aureus in conditions classified elsewhere & of unspecified site New Codes Methicillin resistant staph aureus Methicillim resistant pneumonia due to Staph aureus V12.04 Personal History of MRSA Providence Hospitals 2

3 199.2 Malignant Neoplasm Associated With Transplanted Organ CC diagnosis Revised Fifth digits for Multiple Myelomas & Leukemias 0 = without mention of having achieved remission failed remission has been added as an inclusion term; 1 = in remission 2 = in relapse New Codes For Malignant & Benign Carcinoid Tumors 209.0x 209.6x Carcinoid tumors are considered endocrine because they secrete a hormone serotonin. Carcinoid tumors are often associated with Multiple Endocrine Neoplasia Syndrome (MEN Syndromes) which is coded first Malignant carcinoid tumors of the small intestine Malignant carcinoid tumors of the appendix, large intestine, and rectum Malignant carcinoid tumors of other and unspecified sites Malignant poorly differentiated neuroendocrine tumors Benign carcinoid tumors of the small intestine Benign carcinoid tumors of the appendix, large intestine, and rectum Benign carcinoid tumors of other and unspecified sites Secondary Diabetes (249.xx) includes diabetes resulting from: Medical treatment Drugs Another condition Secondary Diabetes 249.xx 4 th digit identifies presence/absence of complication 5 th digit it identifies controlled vs. uncontrolled Providence Hospitals 3

4 Secondary Diabetes 249.x Chronic Complications: renal manifestations opthalmic manifestations neurlogical manifestation peripheral circulatory manifestations other specified manifestation unspecified manifestation Not a CC or MCC Secondary diabetes 249.x Acute Manifestations ketoacidosis (MCC) hyperosmolarity (MCC) other coma (MCC) without mention of complication Heparin Induced Thrombocytopenia Clinical definition platelet counts that drop by 50% during or after heparin therapy and no other causes of thrombocytopenia are identified. Usually affects 3-5% of patients receiving heparin and treatment is stopping heparin and initiating an alternative anti-coagulant. Not a CC or MCC Headaches & Migraines New Category 339 Other Headache Syndrome Tension Type Headache Category 346 Migraine revision of 5 th digits 0 w/out mention of intractable migraine w/out mention of status migrainosus 1 - with intractable migraine so stated w/out mention of status migrainosus Category 346 Migraine revision of 5 th digits 2 - w/out mention of intractable migraine with status migrainosus 3 with intractable migraine, so stated, with status migrainosus Extensive revisions to inclusions terms & moving things to category 339. Retinopathy of Prematurity 362.2X new fifth digits for stages Retrolental fibroplasia Cicatricial retinopathy of prematurity Retinopathy of prematurity, stage Retinopathy of prematurity, stage Retinopathy of prematurity, stage Retinopathy of prematurity, stage Retinopathy of prematurity, stage Retinopathy of prematurity, stage Other non-diabetic proliferative retinopathy Providence Hospitals 4

5 Cardiovascular New Code Coronary atherosclerosis dur to lipid rich plaque Pleural Effusion New Code Malignant Pleural Effusion Other specified pleural effusion except tuberculosis Hematuria new codes Hematuria unspecified Gross Hematuria Microscopic hematuria Disease & Disorders of Breast Ptosis of breast Hypoplasia of breast Capsular contracture of breast implant Other specified disorders of breast Disorder of Reconstructed Breast x Deformity of reconstructed breast Disproportion of resonstructed breast Pressure Ulcer Stages 707.2x Pressure ulcer stage unspecified Pressure ulcer stage I persistent focal erythema Pressure ulcer stage II partial skin loss involving epidermis Pressure ulcer stage III full thickness skin loss w/ damage or necrosis of subcutaneous tissue Pressure ulcer Stage IV necrosis of soft tissue through to underlying muscle, tendon or bone Pressure ulcer unstagable g Documentation guidelines the MD must make the diagnosis of decubitus/pressure ulcer while other documentation nursing can be used to obtain details about the stage & site of the ulcer Providence Hospitals 5

6 Soft Tissue Disorders Post-traumatic seroma Non-traumatic hematoma of soft tissue Bone Disorders Stress fx of femoral neck Stress fx of shaft of femur Stress fx of pelvis Fever new fifth digits x Fever unspecified Fever with conditions classified elsewhere Post-procedural fever Post-vaccination fever Chills without fever Hypothermia not associated w/ low environmental temperature Functional Problems Functional quadraplegia inability to move due to another condition (arthritis) Functional urinary incontinence leakage of urine due to irreversible impairment in cognitive functioning individual can not exercise baldder control Complications: New Codes Ventilator Associated Pneumonia code assignment based on provider documentation; assign additional code for organism (041.xx) not a code from Other respiratory complications (post-op pneumonia) Complications: New Codes Disruption of wound, unspecified Disruption of traumatic wound injury New inclusion terms for: Disruption if internal surgical wound Disruption if external surgical wound V code 56 new V codes None of the V codes are CCs or MCCs Providence Hospitals 6

7 Surgery Codes 17.1x 17.2x Laparoscopic inguinal hernia repair 53.4X Laparoscopic repair of umbilical hernia Laparoscopic repair of incisional hernia 17.3x Laparoscopic colon procedures Surgery Codes 17.3x Laparoscopic partial excision of large intestine Lap. multiple segmental resection Lap. cecectomy Lap. right hemicolectomy Lap. resection of transverse colon Lap. Left hemicolectomy Lap, sigmoidectomy Other laparoscopic partial excision of large intestine Surgery Codes 17.4X Robotic assisted surgeries in urology, gynecology, general surgery & cardiothoracic Codes are further specified by whether they are open (17.41), laparoscopic (17.42), percutaneous (17.43), endoscopic (17.44), thorascopic (17.45), other & unspecified (17.49). Surgery Codes Excision/Destruction of Left Atrial Appendage (LAA) for treatment of persistent atrial fibrillation by stapling, clip or suturing the LAA with nonabsorbable material. Surgery Codes Laparoscopic total intraabdominal colectomy Open total t intra-abdominal i colectomy Other and unspecified total intra-abdominal colectomy Surgery Pull-through resection of rectum (48.4x) - Performed by dividing and removing the rectum at the level of the sphincter muscle Pull-through resection of rectum NOS Lap pull through resection of rectum Open pull through resection of rectum Other pull through resection of rectum Providence Hospitals 7

8 Surgery Abdominoperineal resection of rectum Anus, rectum, sigmoid colon are removed. Stoma, or opening, is made between the large intestine and the skin Abdominoperineal resection of the rectum, not otherwise specified Laparoscopic abdominoperineal resection of the rectum Open abdominoperineal resection of the rectum Other abdominoperineal resection of the rectum Laparoscopic Repair of Umbilical Hernia Laparoscopic repair of umbilical hernia with graft or prosthesis Other laparoscopic umbilical herniorrhaphy Laparoscopic incisional hernia repair Laparoscopic incisional hernia repair with graft or prosthesis Other laparoscopic repair of other hernia of anterior abdominal wall with graft or prosthesis Repair of diaphragmatic hernia, abdominal approach (53.7x) Laparoscopic repair of diaphragmatic hernia, abdominal approach Other and open repair of diaphragmatic hernia, abdominal approach Repair of diaphragmatic hernia, abdominal approach - NOS Laparoscopic repair of diaphragmatic hernia, with thoracic approach Other and open repair of diaphragmatic hernia, with thoracic approach Anulus Fibrosus Repair Following a surgical diskectomy, an open hole is left in the anulus fibrosus of the disk. Not repairing this defect may contribute to: Recurrent disc herniation Higher rate of reoperation Poor patient outcomes Providence Hospitals 8

9 80.53 Repair of the anulus fibrosus with graft or prosthesis Other and unspecified repair of the anulus fibrosus Sugery Total Reconstruction of the Breast (85.7x) Total reconstruction of breast, not otherwise specified Perforator flap, free Latissimus dorsi myocutaneous flap Transverse rectus abdominis myocutaneous (TRAM) flap, pedicled Sugery Total Reconstruction of the Breast (85.7x) Transverse rectus abdominis myocutaneous (TRAM) flap,fre Deep inferior epigastric artery perforator (DIEP) flap, free Superficial inferior epigastric artery (SIEA) flap, free Gluteal artery perforator (GAP) flap, free Other total reconstruction of breast Hospital Acquired Conditions - for POA indicators N & U the following conditions will no longer qualify as CC/MCC Foreign Object Retained After Surgery = (CC) & (CC) Air Embolism (MCC) Blood Incompatibility (CC) Pressure Ulcers Stage III & IV & (MCC) Hospital Acquired Conditions continued Fall & Trauma (fx, dislocations, intracranial injury, crushing injury, burn & electric shock , , , , , Catheter Associated UTI (CC) the UTI code assigned as additional code will also be excluded from acting as a CC/MCC Hospital Acquired Conditions continued Vascular Catheter Associated Infection (CC) Manifestations of Poor Glycemic Control (MCC), (MCC), (CC), (MCC), (MCC) Providence Hospitals 9

10 Hospital Acquired Conditions continued Surgical Site Infection Mediastinitis following CABG (MCC) w/ procedure codes Surgical Site Infections Following Certain Orthopedic Procedures & 998. Surgical Site Infections Following Bariatric w/ PDx Hospital Acquired Conditions continued DVT & PE Following Certain Orthopedic Procedures (MCC), (MCC) & (MCC) Providence Hospitals 10